• Testicular Cancer primarily affects young men, typically between the ages of 15 and 45, making early awareness vital.
• The most common early signs of testicular cancer include a painless lump or swelling in the testicle, a feeling of heaviness, or a dull ache in the groin.
• Regular self-examinations are key to knowing how to check for testicular cancer and detecting abnormalities promptly.
• Testicular cancer diagnosis involves a physical exam, ultrasound, and blood tests for tumor markers, followed by surgical removal for definitive diagnosis and staging.
• Testicular cancer treatment options are highly effective and often include surgery, with chemotherapy or radiation therapy used for more advanced cases.

What is Testicular Cancer?

Definition and Types

What is testicular cancer? It is a malignancy that develops in one or both testicles, which are responsible for producing sperm and testosterone. This cancer is relatively uncommon, accounting for approximately 1% of all male cancers, yet it is the most common cancer among men aged 15 to 45 years. The vast majority of testicular cancers, about 90-95%, are germ cell tumors, meaning they originate from the cells that produce sperm.

Germ cell tumors are broadly categorized into two main types:

• Seminomas: These tend to grow and spread more slowly than non-seminomas. They are typically very sensitive to radiation therapy and chemotherapy.
• Non-Seminomas: This group includes several subtypes such as embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. Non-seminomas often grow and spread more quickly and may require different treatment approaches compared to seminomas. Some tumors can be a mix of both seminoma and non-seminoma cells.

Prevalence and Outlook

While Testicular Cancer is rare overall, its incidence has been slowly increasing in many parts of the world. According to the American Cancer Society, approximately 9,760 new cases of testicular cancer are diagnosed in the United States each year. Despite this, the outlook for individuals diagnosed with this condition is remarkably positive, especially when detected early. The overall 5-year survival rate for testicular cancer is about 95%, and for localized cancer (cancer that has not spread outside the testicle), the survival rate is even higher, close to 99%. This high survival rate underscores the importance of early detection and effective testicular cancer treatment options.

Early Signs and Self-Examination

Common Symptoms to Watch For

Recognizing the early signs of testicular cancer is paramount for prompt diagnosis and successful treatment. While many conditions can cause similar symptoms, any persistent changes should be evaluated by a healthcare professional. The most common testicular cancer symptoms include:

• A painless lump or swelling in either testicle, which can be pea-sized or larger. This is the most frequent symptom.
• A feeling of heaviness in the scrotum.
• A dull ache in the abdomen or groin.
• Sudden collection of fluid in the scrotum (hydrocele).
• Pain or discomfort in a testicle or the scrotum.
• Enlargement or tenderness of the breasts (due to hormone-producing tumors, though rare).
• Back pain (if the cancer has spread to lymph nodes in the back).

It is important to note that most testicular lumps are not cancerous, but any new lump or change should always be investigated by a doctor.

Performing a Testicular Self-Exam

Knowing how to check for testicular cancer through regular self-examinations is a simple yet effective way to detect changes early. Men should perform a testicular self-exam (TSE) once a month, ideally after a warm bath or shower when the scrotal skin is relaxed. Here’s how to do it:

1. Stand in front of a mirror and look for any swelling on the scrotal skin.
2. Examine each testicle with both hands. Place your index and middle fingers underneath the testicle and your thumbs on top.
3. Gently roll the testicle between your thumbs and fingers. You should feel a soft, tube-like structure at the back of the testicle; this is the epididymis, which stores and carries sperm.
4. Feel for any lumps, smooth rounded masses, or changes in the size, shape, or consistency of the testicle. It’s normal for one testicle to be slightly larger than the other.
5. If you find any new lump, swelling, or experience pain, consult a doctor immediately.

Understanding Risk Factors

Genetic and Environmental Influences

While the exact causes of testicular cancer are not fully understood, several risk factors have been identified that can increase a man’s likelihood of developing the disease. It’s important to remember that having one or more risk factors does not mean a man will definitely get testicular cancer, and many men who develop it have no known risk factors.

Key risk factors include:

• Cryptorchidism (Undescended Testicle): This is the strongest risk factor. It occurs when one or both testicles fail to descend into the scrotum before birth. Even if surgically corrected, the risk remains higher than for those without cryptorchidism.
• Family History: A man with a father or brother who had testicular cancer has an increased risk.
• Previous Testicular Cancer: Men who have had cancer in one testicle have a significantly higher risk of developing it in the other testicle.
• Race and Ethnicity: White men are at a higher risk than men of other races, with the highest rates observed in North America and Europe.
• HIV Infection: Men infected with HIV, especially those with AIDS, have an increased risk.
• Carcinoma in Situ (CIS): This is an abnormal growth of germ cells in the testicle that is not yet cancer but can develop into it.

Environmental factors are less clearly defined, but research continues to explore potential links between exposure to certain chemicals or conditions and an increased risk of Testicular Cancer.

Diagnosis of Testicular Cancer

Initial Assessment and Imaging

When a man presents with suspicious symptoms, a thorough testicular cancer diagnosis process begins. The initial steps typically involve a physical examination by a doctor, who will carefully feel the testicles and scrotum for any lumps, swelling, or tenderness. Following this, an ultrasound of the scrotum is usually performed. This imaging test uses sound waves to create detailed pictures of the testicles and can help determine if a lump is solid (more likely to be cancerous) or fluid-filled (usually benign).

Blood tests are also crucial for diagnosis. These tests measure levels of tumor markers, which are substances produced by certain cancers. The primary tumor markers for testicular cancer include:

Elevated levels of these markers can strongly suggest the presence of testicular cancer, though normal levels do not rule it out entirely.

Biopsy and Staging

Unlike many other cancers, a needle biopsy is rarely performed for suspected Testicular Cancer due to the risk of spreading cancer cells. Instead, if imaging and blood tests suggest cancer, the affected testicle is surgically removed through an incision in the groin (radical inguinal orchiectomy). This procedure serves as both the definitive diagnostic biopsy and often the primary treatment. The removed testicle is then examined by a pathologist to confirm the diagnosis, determine the type of cancer, and assess its aggressiveness.

Once the diagnosis is confirmed, further tests, such as CT scans of the abdomen, pelvis, and chest, may be conducted to determine if the cancer has spread beyond the testicle. This process is called staging, which helps doctors understand the extent of the cancer and plan the most appropriate testicular cancer treatment options. The stage of the cancer is a critical factor in determining prognosis and guiding subsequent management.

Testicular Cancer Treatment Approaches

Surgical Options

The primary and often curative testicular cancer treatment options begin with surgery. The initial surgical procedure for confirmed or highly suspected testicular cancer is a radical inguinal orchiectomy. This involves removing the entire affected testicle and spermatic cord through an incision in the groin. This surgery is typically performed under general anesthesia and is highly effective in removing the primary tumor. For many men with early-stage disease, this may be the only treatment required, followed by active surveillance.

In some cases, particularly for non-seminoma tumors that have spread to the retroperitoneal lymph nodes (lymph nodes located deep in the abdomen), a more extensive surgery called retroperitoneal lymph node dissection (RPLND) may be necessary. This procedure involves removing these lymph nodes to check for cancer spread and to remove any cancerous nodes. RPLND is a complex surgery that requires specialized expertise.

Chemotherapy and Radiation

Beyond surgery, other treatments are employed depending on the type and stage of the cancer. Chemotherapy is a systemic treatment that uses powerful drugs to kill cancer cells throughout the body. It is frequently used for advanced Testicular Cancer, or as an adjuvant (additional) therapy after surgery to reduce the risk of recurrence, especially for non-seminoma types or if tumor markers remain elevated. The specific chemotherapy regimen and duration depend on the cancer’s characteristics and spread.

Radiation therapy uses high-energy rays to kill cancer cells. While it is highly effective for seminoma, particularly in early stages or if cancer has spread to nearby lymph nodes, it is less commonly used for non-seminoma types, which are generally less sensitive to radiation. For early-stage seminoma, radiation to the lymph nodes in the abdomen and pelvis may be an option, or active surveillance may be chosen. The decision for chemotherapy or radiation is made collaboratively between the patient and a multidisciplinary team of specialists, considering the specific cancer type, stage, and individual health factors.